亚甲蓝示踪在乳腺癌前哨淋巴结活检中的应用及影响因素  

Application of Methylene Blue Dye to Sentinel Lymph Node Biopsy in Breast Cancer and Its Influencing Factors

作　　者：黄晓燕[1] 吴炅[1] 刘哲斌[1] 张家新[1] 韩企夏[1] 徐维萍[2] 平波[2] 杨文涛[2] 沈镇宙[1] 邵志敏[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系/复旦大学附属肿瘤医院乳腺外科,上海200032 [2]复旦大学上海医学院肿瘤学系/复旦大学附属肿瘤医院病理科,上海200032

出　　处：《癌症》2007年第10期1133-1137,共5页Chinese Journal of Cancer

基　　金：上海市科委科研基金资助项目(No54119524);上海市教委曙光计划资助项目(No05SG04)~~

摘　　要：背景与目的:示踪剂的选择是影响乳腺癌前哨淋巴结活检成功与否的重要因素之一。本研究探讨亚甲蓝作为示踪剂在乳腺癌前哨淋巴结活检中的应用价值,并分析影响其示踪结果的各项因素。方法:选取2005年3月至2006年2月复旦大学附属肿瘤医院治疗的101例可手术乳腺癌患者作为研究对象,临床体检腋窝淋巴结阴性,均单独采用亚甲蓝作为前哨淋巴结活检示踪剂。前哨淋巴结活检后均行腋窝淋巴结清扫。应用石蜡连续切片、HE染色进行病理诊断。结果:本组前哨淋巴结检出率为96.04%(97/101),假阴性率为11.76%(4/34),术前未行化疗患者的假阴性率为7.40%(2/27)。平均检出前哨淋巴结2.05枚。前哨淋巴结的大小与病理结果相关。病理类型、新辅助化疗、局部切除活检对本组前哨淋巴结的检出率均无影响。前哨淋巴结数量与假阴性率相关;体重指数(bodymassindex,BMI)对检出率、假阴性率均有影响。本组患者未发生过敏反应及皮肤坏死。结论:亚甲蓝作为乳腺癌前哨淋巴结活检的示踪剂安全、可靠;对于BMI较高的患者,需要进一步改进示踪方法。BACKGROUND ＆ OBJECTIVE： Tracer is one of the important influencing factors for the successiveness of sentinel lymph node biopsy （SLNB） for breast cancer. This study was to evaluate the efficacy of methylene blue dye （MBD） as a tracer in SLNB for breast cancer, and to analyze its influencing factors. METHODS： From Mar. 2005 to Feb. 2006, 101 operable breast cancer patients with clinically negative axillary lymph node were enrolled. MBD was used alone as the tracer agent for SLNB. Axillary dissection was performed after SLNB. All sentinel lymph nodes （SLNs） were examined pathologically with HE staining. RESULTS： In this series, the identification rate of SLNs was 96.04% （97/101）. The false negative rate was 11.76% （4/34）. Excluding the patients received neoadjuvant chemotherapy, the false negative rate was 7.41% （2/27）. The mean number of SLNs harvested was 2.05 in each patient. The size of SLNs was related to the pathologic results. Histological type, neoadjuvant chemotherapy, excisional biopsy had no impact on the identification rate of SLNs. The number of SLNs was correlated to the false negative rate of SLNB. The body mass index （BMI） was related to the identification rate of SLNs and the false negative rate of SLNB. No allergic reaction and skin necrosis had been observed. CONCLUSIONS： MBD is a safety, reliable tracing agent for SLNB in breast cancer. Improved tracing technology is needed for the patients with higher BMI.

关 键 词：乳腺肿瘤 诊断 前哨淋巴结 组织活检 亚甲蓝 

分 类 号：R737.9[医药卫生—肿瘤]